Guided Self-Help as Intervention for Traumatic Stress in Parents of Children with Cancer: Conceptualization, Intervention Strategies, and a Case Study

Figures & data

FIGURE 1 Proposed conceptualization of traumatic stress in parents of children with cancer.

TABLE 1 Overview of Treatment Components and Content

Module 1	Introduction to treatment model and psychoeducation. Participants are introduced to the treatment model and are provided psychoeducation regarding emotional responses when being a parent of a child with serious illness.
Module 2	Bodily tension and introduction to relaxation training. Participants are provided with information regarding bodily tension and learned to discriminate between tension and relaxation.
Module 3	The power of thinking and introduction to detached mindfulness and defusion. Participants are introduced to the concepts of defusion and detached mindfulness. They are taught “to catch themselves” when stuck with cognitive content and trained in applying strategies for defusing from cognitive content, i.e., to shift the style of cognitive processing.
Module 4	How rules and assumptions affect our behavior and introduction to behavioral experiments. Participants are introduced to the concepts of rules and assumptions and how these may affect subsequent behavior and their consequences. Participants are taught to analyze the consequences of following rules and to try out to new behaviors, if consequences are unwanted, i.e., behavioral experiments.
Module 5	Structured writing assignments, acceptance, and willingness. Participants are introduced to the concepts of acceptance and willingness and how this type of behavior functions in their everyday life. They are introduced to practicing acceptance and willingness through a series of writing assignments.
Module 6	Structured writing, perspective taking, self-compassion, and sharing with others. Participants are introduced to the concept of perspective taking as a way of fostering self-compassion. They are taught to practice shift in perspective through writing assignments.
Module 7	Values, goals, and valued action. In this section participants are introduced to the concepts of values, goals and valued action. They are taught that values are something that you will never get done with, that you always can act in accordance with your values. Participants practice generating goals that are in accord with their values and acting on these goals
Module 8	Recap, maintenance, and general self-care. In this section participants get a précis of the entire program. They are instructed to generate a maintenance-plan and are introduced to general self-care activities, i.e., general sleep hygiene, exercise and good eating habits.

TABLE 2 Scores for Maria at Pre-, Post- and Follow-Up-Assessment Compared to Clinical and Nonclinical Norms

				Clinical		Nonclinical
	Maria			Norms		Norms	Critical	Critical
	Pre-	Post-	Follow-up	M (SD)		M (SD)	Cutoff	Change
PCL-C	48	31^f	29^f	49.9 (9.1)^a		29.0 (7.5)^a	38.5	5.5
QOLI	−0.25	2.06^f	1.63	0.9 (1.6)^b		2.6 (1.1)^c	1.9	1.7
MADRS-S	24	8^f	10^f	20.1 (5.7)^d		7.85 (8.4)^e	15.2	5.0
Rumination	11	3	6	NA		NA	NA	NA
AAQ-PCC	67	83	82	NA		NA	NA	NA
Note. PCL-C = PTSD Checklist–Civilian; QOLI = Quality of Life Inventory; MADRS-S = Montgomery Åsberg Depression Rating Scale–Self Assessment; AAQ-PCC = Acceptance and Action Scale–Parents of Children with Cancer; NA = not available.
^a Pöder, et al., 2008.
^b Carlbring et al., 2005.
^c Frisch, et al., 1992.
^d Bergström et al., 2003.
^e Holländare et al., 2008.
^fClinically significant and reliable change from preintervention assessment.

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